Keli Mu, Helene Lohman, Linda S. Scheirton, Teresa M. Cochran, Brenda M. Coppard, Stephanie R. Kokesh; Improving Client Safety: Strategies to Prevent and Reduce Practice Errors in Occupational Therapy. Am J Occup Ther 2011;65(6):e69-e76. doi: 10.5014/ajot.2011.000562.
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© 2018 American Occupational Therapy Association
OBJECTIVE. This qualitative focus group study investigated the strategies to prevent or reduce practice errors used by occupational therapists who practice in physical rehabilitation and geriatrics.
METHOD. A total of 34 occupational therapists from four geographic regions across the United States participated in four focus groups. Participants worked in the areas of physical rehabilitation or geriatrics and had a minimum of 1 year of practice. Participants responded to open-ended, guiding questions. Data collected from the focus groups were analyzed qualitatively for themes.
RESULTS. Analysis of the collected data yielded four themes related to specific strategies occupational therapists use to prevent or reduce practice errors: (1) strengthen orientation and mentoring for new therapists, (2) ensure competency through performance competency checks, (3) enhance existing or establish new safety policies and procedures, and (4) advocate for the profession and for systemic change.
CONCLUSION. Findings of the study suggest that occupational therapists implement various discrete strategies to prevent or reduce practice errors and improve client safety. Occupational therapy practice and professional training must emphasize the inevitability of practice errors; the importance of orientation and training, including assertiveness training; and the inclusion of performance-based competency checks.
Well—for example, with transfers—we have new employees. Even if they’ve got some experience, we have one of the [assistants] we’ve designated as skilled in transfer training… . I set up with him for 30 min to go over basic transfers. ‘I don’t want you to move your back this way; if this patient presents like this, this is the way we want you to do it … and now you lift me and I lift you.’ So there’s a lot of hands on.
Coaching done properly is helpful … . I am more [in favor] of the coaching model and trying not to instill the fear because you want people to learn. And you want them to come if there’s an error, and you want them to say, “I don’t know how to do this.” [Mentoring should include] very carefully molded coaching [and] knowledge of how to coach people and how to grow them.
We have a huge competency program that we have set up that is population and technique specific … . We have these populations—diagnostic groups—and all these interventions. You don’t get assigned a specific case until you have gone through a certain level of competency … . It’s a very systematic way … and I would say that in the 3 years that I’ve been in the same facility, I haven’t seen so-called practice errors.
As an educator, I think it’s really important in occupational therapy school that we train our students on all different kinds of documentation… . So that if I’m going to work a PRN [as-needed] job and I go into a skilled nursing facility, I should know what those kinds of forms look like and where I’m going to write things and where to find things. And if I’m going to go into an acute hospital I should know about that … and then if I’m going to go into rehab… . They’re all totally different ways of documenting. You need to talk about where information is, and where to get it, and where to put it for other people to read.
Therapists know what’s right and wrong, but their work is putting them in situations and requiring them to do things. And it is very difficult for someone who needs their job to tell their companies they’re not going to do what they’re being told.
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